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Enrollment in Md. Obamacare ends, equals ’16 insured

Maryland Gazette (MD)

The fifth open enrollment period for the Affordable Care Act closed in Maryland Friday, and while the same number of people have signed up for health insurance as last year the law remains under threat from Washington.

About 150,000 Marylanders have signed up for insurance in 2018 under the law known as Obamacare, which provides coverage to those who do not get coverage through work.

Maryland had extended the enrollment period by one week after initially agreeing to a shortened, 45-day period set by the administration of President Donald Trump.

The health law will remain unchanged in the new year, but a provision in the massive just-passed federal tax bill would end the financial penalty for going without health insurance in 2019. Observers and analysts say that could undermine the law if young and healthy people skip coverage and cause rates to rise for those left - independent analysts say millions of people could leave the marketplace. Insurers have already raised rates substantially because federal officials stopped some subsidy payment to them.

"It's hard to say exactly what the future will bring, but it's a pretty safe bet that the rolls of the ACA will drop very significantly as federal subsidies decrease and as premiums skyrocket once healthy people leave the insurance pool," said Jonathan P. Weiner, a Johns Hopkins University professor of health policy and management.

Subsidies that off-set the cost of premiums for about 75 percent of consumers in the Maryland market remain in tact, and have gone up with the price of policies. But so-called cost-sharing subsidies afford just over half of enrollees to off-set out-of-pocket expenditures were cut off in October.

Weiner said some "wealthy blue states -- like Maryland" are likely to consider their own requirements for coverage and subsidy payments. But that would likely be patchwork and not as effective.

Advocates say they will push the state legislature to shore up the federal health law, possibly in several ways such as a requirement to buy insurance. Gov. Larry Hogan, a Republican, did not respond to request for comment on the prospects for such a mandate or other measures.

"By making the federal individual mandate unenforceable, Congress has greatly undermined the ACA's individual insurance markets," said Vincent DeMarco, president of the Maryland Citizens' Health Initiative. "The General Assembly can and should help protect Marylanders' health care coverage by making sure the federal individual mandate is enforced in our state."

Leni Preston, president of Consumer Health First, said the state-based exchange was able to maintain its enrollment by investing in marketing, outreach and consumer assistance, which were all cut on the federal exchange used by most states. The extra week for open enrollment also helped.

"All of that said, the impact of the loss of [subsidy] payments meant higher rates for 2018," she said. "Therefore, Maryland must take positive steps to both stabilize the individual market and ensure affordable health insurance options."

She said the advocacy group is exploring legislative options, such as a state mandate and a reinsurance program that would help insurers cover the cost of their most expensive consumers, though funding such a program could be tough.

Iinsurers said they had already had factored in a lack of enforcement of the mandate in submitting their requests to raise rates in the coming year -- CareFirst BlueCross BlueShield initially said it amounted to about a fifth of its double digit rate requests.

Consumers protested the big increases, with some reporting to the state's insurance commissioner that their premiums have doubled or more in the last few years, increases that were unsustainable for the quarter of all enrollees who do no get any federal subsidies.

So far, the Medicaid program that provides coverage to the poor has escaped cuts. Under the health law, Maryland expanded coverage to about 290,000 more residents. But at issue in Maryland and across the country is the fate of the health program that covers about 9 million low-income children, including about 146,000 in the state.

The program, the Children's Health Insurance Program, or CHIP, expired in September and has not been reauthorized by Congress. Lawmakers said Thursday they would fund the program through March.

Some states say they have or are near the end of their funding; Maryland expects to run out of money by April.

In a letter to congressional leaders earlier this month urging action, Hogan said the loss in federal matching funds would amount to $30 million in fiscal 2018 and rise to $121 million in fiscal 2019.

"This potential worst-case outcome places a tremendous financial and administrative burden on our state and sows fear and confusion among some of our most vulnerable populations," Hogan wrote.

It's not clear if the children would continue to receive healthcare benefits is the program is discontinued. Bradley Herring, a Hopkins health economist, said the potential for the new tax bill to balloon the debt by $1 trillion may lead lawmakers to look for ways to cut long-term spending on large expensive programs like Medicaid, Social Security and Medicaid.

"It's been a bipartisan thing for a long time," Herring said of the children's program. "But I could imagine representatives saying something along the lines of we have such a huge deficit and we can't continue to spend money on these entitlements."